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Atrakurium dan Magnesium Sulfat untuk Mencegah Peningkatan Serum Kreatinin Fosfokinase dan Ion Kalium akibat Induksi Suksinilkolin

Authors
Publisher
Perhimpunan Dokter Spesialis Anestesiologi dan terapi Intensif
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Keywords
  • Suksinilkolin
  • Magnesium Sulfat
  • Kalium
  • Fasikulasi

Abstract

Background: Succinylcholine is commonly used for intubation and induction, short operation emergency, day case anaesthesia and difficult airway controlled. Unexpected complication after succinylcholine administration is fasciculation, myalgia and increase of potassium blood level and creatin phosphokinase serum.Methods: This research was a clinical trial stage I (human sample) for 60 patients benign breast tumors undergoing surgery by general anesthesia. All patients were observe the 6 hours fasting period and give no premediacation. Peripheral blood sample were taken to measure the potassium level and creatin phosphokinase serum before premedication given. Patients randomly divided in to two grou., group I pretreatment with atrakurium 0,05 mg/kgBW and group II pretreotment with MgSO4 40mg/kgBW. Induction with succinylcholine 1,5mg/kgBW fifteen minute after premedication. Seven minute after induction, peripheral blood sample were taken on contralateral inffusion to measure potassium blood level after induction and 24 hours post operation. Peripheral blood sample were taken on contralateral infusion to measure creatine phosphokinase serum level. Statistical analysis were performed by independent t-test, Mann-Whitney U test and rank spearman correlation which were p = 0,05 was considered significant.Results: There was no difference for patients characteristics distribution data, creatin phosphokinase serum and blood potassium level before induction between two groups, For potassium blood level elevation between two group were significantly difference ( p = 0,029). Creatin phosphokinase level elevation between two group were no significantly difference ( p > 0,05 ). There was no significantly correlation (p = -0,138; p = 0,466) proved is between creatin phosphokinase serum and blood potassium level elevation on atrakurium group such no significantly correlation (p = 0,186; p = 0,325) proved is between creatine phosphokinase serum and blood potassium level elevation on atrakurium group.Conclusions: The administration of 40% magnesium sulphate 40 mg/kg BW could prevent the elevation of serum creatin phosphokinase following succinylcholine induction and blood potassium ion level, althought not as effective as atrakurium but better than other pretreatment.Keywords : succinylcholine, magnesium sulphate, potassium, potassium, fasciculationABSTRAKLatar belakang: Pemakaian suksinilkolin sebagai fasilitas intubasi dan induksi masih merupakan pilihan untuk tindakan yang singkat, emergensi, rawat jalan dan keadaan dimana jalan napas belum tentu dapat dikuasai. Efek samping yang sering timbul adalah fasikulasi dan mialgia yang ditandai meningkatnya kadar serum kreatin fosfokinase (CPK) dan ion kalium.Metode: Penelitian ini merupakan uji klinik tahap I ( subyek manusia ) pada 60 penderita tumorjinak mama yang menjalani operasi dengan anestesi umum. Semua penderita dipuasakan 6 jam dan tidak diberi obat premedikasi.Pengambilan sampel darah perifer di daerah antebrakhii kontralateral infus untuk pemeriksaan kadar ion kalium dan kreatin fosfokinase sebelum induksi. Penderita dikelompokkan secara random menjadi 2 kelompok. Kelompok I mendapat pretreatment atrakurium 0,05 mg/kgBB dan kelompok II mendapat pretreatment MgSO4 40% 40 mg/kgBB. 15 menit kemudian dilakukan induksi dengan suksinilkolin 1,5 mg/kgBB pada masing-masing kelompok. 7 menit setelah intubasi dilakukan pengambilan sampel darah perifer kontralateral infus untuk pemeriksaan kadar ion kalium pasca perlakuan dan 24 jam setelah operasi dilakukan pengambilan sampel darah perifer kontralateral infus untuk pemeriksaan kadar kreatinin fosfokinase. Uji statistik menggunakan independent t-test dan Mann-whitney U test serta uji korelasi dengan rank Spearman dengan derajat kemaknaan p = 0,05.Hasil: Tidak ada perbedaan yang bermakna pada distribusi karateristik penderita serta kadar serum kreatin fosfokinase dan kadar kalium sebelum perlakuan. Peningkatan kadar ion kalium antara kelompok atrakurium dan kelompok magnesium sulfat terdapat perbedaan bermakna (p = 0,029) dan peningkatan kadar serum kreatin fosfokinase antara kelompok atrakurium dan kelompok magnesium sulfat tidak terdapat perbedaan bermakna ( p > 0,05 ). Hasil uji hubungan menunjukkan tidak terdapat hubungan bermakna (p= - 0,138; p =0,466) peningkatan kadm kalium dan peningkatan kadar CPK pada kelompok atrakurium demikian juga hasil uji hubungan menunjukkan tidak terdapat hubungan bermakna (p = 0,186; p = 0,325) peningkatan kadar kalium dan peningkatan kadar CPK pada kelompok MgSO4.Kesimpulan: Pemberian Magnesium Sulfat 40% 40 mg/kgBB dapat mencegah peningkatankadar kreatin fosfokinase serum dan kadar kalium darah, meskipun tidak seefektif Atrakurium, tetapi lebih baik dibanding yang lain.Kata kunci : suksinilkolin, magnesium sulfat, kalium, fasikulasi

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